Laughing Gas for Labor? I’ve Been There

Nitrous oxide for labor? Common Health asks why the drug, which is so readily used in other countries, is no where to be found in labor and delivery rooms in the United States.

Why don’t women in the U.S. have access to nitrous oxide, a safe, inexpensive and fairly simple option for alleviating pain during labor, when women in almost all other developed countries use it widely?

A small band of midwives, doctors and mothers are trying to find out.

Sure, nitrous oxide (aka laughing gas, like you get in the dentist’s office) doesn’t have the super-pain-relieving magic of an epidural. Instead, it offers something closer to an elixir of dulled pain tempered by nonchalance, says William Camann, chief of obstetric anesthesia at the Brigham & Women’s Hospital and the co-author of the book “Easy Labor.” “The pain may still exist for some women but the gas may create a feeling of, ‘Painful contraction? Who cares?’”

So, while nitrous oxide is used by about 50% of laboring women the United Kingdom; 60% in Finland and widely in Canada, according to a published review, it’s available only in two U.S. hospitals.

It seems like the major roadblock is just that since we’ve never used it, it never occurs to the U.S. medical system to try.

However, hospitals to occasionally use laughing gas during births, as I can attest. During my own extended labor we discovered that each epidural “boost” was becoming less effective, including the one that was given to me prior to my emergency c-section. When the final injection wore off during the middle of my surgery, I was given the option of total anesthesia, which I knew would make me unconscious for hours, or the use of laughing gas to get me through the final removal of the placenta and the subsequent sewing up.

I chose the nitrous oxide, knowing that it meant I would be awake, mostly alert and able to move around more quickly during my post-op recovery. I most definitely felt the pain, but it tempered it enough to get me through surgery, which was all I wanted at that point.

Could laughing gas be a viable option for the actual act of labor? I’m not sure, but it will be difficult to ever know if we aren’t given an option to try it.

Could laughing gas be a viable option for the actual act of labor? I’m not sure, but it will be difficult to ever know if we aren’t given an option to try it.

Or if articles discussing the subject don’t delve into the safety and effectiveness statistics and learned experiences of the use of NO2 in the countries where it is routine….

Even the linked article has a quote from only one (U.S.-based) doctor talking about the U.K., and no numbers on what the rate of complications and such resulting from the use of NO2 (which is what anyone will want to know for a medical technique they weren’t aware of before).

Nitrous oxide in labor sounds like a pretty inspired idea, but it’s not like it’s an amazing new idea that no one knows how well it would work and we just need some pioneers/guinea pigs to try it out—it’s old hat in these other countries (U.K., Finland, Canada, maybe others?), so all you’d need to do to make a case is look through their medical statistics. I get the impression that FDA approval isn’t even an issue here, so all that would be needed is to spread the word with some facts backing it up.

robin-marty

I will admit there was one point where I yelled “Oh my god I can feel them pulling out my placenta!” so that was sort of, um, interesting…

But given the choice between a bit of pain and consciousness, and no pain but being out of it for hours after, I’d definitely do the same again. If my epidural doesn’t work during this csection, I will take the exact same route.

radicalhousewife

“Painful contraction? Who cares?” A laboring mom could read this line and have the same effect! Seriously, though, why not go through the ordeal with a nice buzz happening? I hated my epidural so much I went med-free the second time around. I didn’t think to have a six pack of Summit in the delivery room, but maybe I should have.

robin-marty

It was the second, third, and fourth I began to hate. No one should ever get stuck in labor for more than 2 days.

prochoiceferret

(Oops… it’s supposed to be N2O, not NO2. Breathing in nitrogen dioxide during labor probably wouldn’t be very pleasant!)

I doubt that N2O has enough kick to make labor completely pleasant. Although I recall hearing somewhere of its use as an aphrodesiac and/or sexual enhancer, so maybe if one combines that with a vibrator and nipple/clit stimulation, it might make one of those mythical orgasmic births more likely!

saltyc

I hated the epidural, I hate being sedated.

I was trying to go without, but finally gave in and asked for it, and the anaesthesiologist was all like “he-yyyyy I’m here! The ladies are always happy to see meee!!!” I wanted to punch him in the face. The epidural just made me lose all strength, made the contractions weaker and dragged the labor out a bit longer. I was glad to have it, and I wanted the option, but please dudes, don’t act like the pusher guy entering a party when you come in, jeeez.

prochoiceferret

I was trying to go without, but finally gave in and asked for it, and the anaesthesiologist was all like “he-yyyyy I’m here! The ladies are always happy to see meee!!!”

Good Lord. Your labor briefly turned into a Seinfeld episode :-[

saltyc

No, it was a good thing I didn’t actually say anything, because he might have pulled back the syringe and said “No Epidural for you!”

nycprochoicemd

I hate to be so negative, but the truth is that nitrous oxide requires more monitoring from nurses (+$$$), requires response to mom’s discomfort (+$ + ‘aggravation’), doesn’t turn mom numb (+++required response and support to mom –> +$$ + ‘aggravation’), probably decreases use of epidural (—-$$$$)

I say aggravation because honestly that’s how a lot of people treat women who are in pain during labor, not because moms in pain are inherently aggravating (I would venture to say that moms in pain during labor are inherently normal)

Please fight for this, moms-to-be and the people who love them… Nobody else will because it’s not in anyone else’s interest.

I don’t have any kind of published data to support these statements, by the way, it’s just what I imagine based on my experience on L&D.

The holdup to hospitals providing this type of anesthesia has been (at least in part) concern about side effects, which seem to have been laid to rest, and availability of delivery equipment which protects staff from the effects of gas. A company has come forward for this and now the FDA has to approve or at least allow. So N20 for labor may be offered in the US at last!

Documents and discussion about these issues are available on the N2Oduringlabor group site.

I have to say that I agree (anecdotally also) with NYProChoiceMD that some of the resistance will be due to nursing staffing shortages and an attitude that helping women cope with labor is too much trouble. Consumer pressure and support for this method could be helpful in the process.

Those of us supporting the introduction of nitrous oxide in labor in the US see it as an additional tool for helping women cope. Unlike epidural pushers, we do not believe that all women will need nitrous oxide if they don’t have an epidural.

One of its pluses is that for this purpose administration of the gas is controlled by the woman, not the nurse, the midwife, the obstetrician, or the anesthesiologist. The woman holds the mask to her face. When she has had enough, she takes it away — or her hand falls away if she’s taken in enough to be groggy. While not empowering in the way a natural birth is, at least this method of pain relief is in the woman’s control. If it works for her to get her through the tough parts, fine. If she hates it, she just stops using it.